Home Forums Discussions Problems working with several patients at the same time

Hello everybody,

Today I had several patients in the rooms, being seen simultaniously. Meaning, I would go to one room, while MA puts pt in another, while another MA does something for the pt per my orders. While I go to the second room, MA goes to the first doing some orders, etc.
I do not know how to open multiple pt's charts so I can type, write A&P, meds etc while switching between the pts. Got very stressed since this inability (i hope just a lack of knowledge) did really slow me down.
Any solutions?

There are none. The only way would either be with another computer or, more feasible, would be Virtual Machines. With VMWare or someting of that nature, you could have five, six, seven ACs open at the same time. Just have to keep in mind that you must pay for a license for each OS, which could be rather costly.

But, on one computer with one OS, you can only open one chart. You can, however use CTRL - S to save a chart instantly to your inbox.

Thank you for the prompt response.
What if I assign full privileges to one of my MAs and at least have 2 pts opened simultaniously on two computers?
Just out of curiosity - why would developers miss on such a feature? Look what is happening with browsers - even Internet Explorer has tabs now, not mentioning Firefox and Chrome.

The AC interface was written in VB and access code which is ancient

Well, I am a newbie, but when you leave the room you can forward the chart to your MA's inbox,when they have done their thing they can forward it back to your box.The problem is that you cannot retrieve a chart from another person's inbox.
Last week we were having some problems with missing information....the medication list was populated by the staff before the chart was sent to my inbox, but for some reason the chart that I opened did not contain the information which I could then get to show up with some manuevers that are too tedious to take the time to describe. I am not at all sure what that was about, but that sort of problem would limit the usefulness of forwarding to the next inbox in the sequence. Maybe there could eventually be a "holding box" for charts, a common place accessible to all. The inbox would be the equivalent of the chart is "on your desk" the holding box is the equivalent of the chart is "in the exam room" and the saved charts are in " the file cabinet" ( complete and signed). I am glad I am not a programmer.

Deborah,

I love the idea of a holding area.

Possibly a suggestion to AC or putting this in the "Wish List"Area would move things along.

Frank J. Paiano, DO
Internal Medicine
Leesburg, FL

We deal with this by having a totally separate "Nurse" chart. The nurses put the vitals in my note before I go in the room. Anything else that the assistants do, labs, shots, etc, gets documented in the nurse note. It is later sent to me to sign off on.

Deborah, I'm not sure how this functions, but you can recall a chart from another inbox. Change your inbox to "sent" then select the message, now click "retrieve" on the right. I'm not sure if it will include any updates to the chart though. I don't expect it too, but it may help when you realize you meant to add something else.

Oh, and YES! I wish very much that there were shared inboxes. One for the MA's and one for the Providers. Times vary, and sometimes we want the first available provider to see the patient.

If that were done it would be nice if there were also an improvement over the current drop down menu so inboxes could be quickly switched between. If I enter this in the wish list would you comment on it so it looks more important to the Jon and the programmers?

EasyRider, you can log in yourself on two computers to have two charts open simultaniously, and as they said, you can quickly save the current working copy of the chart to your inbox with the shortcut CTRL-s.

What is a virtual machine? like a thin client set up for the exam rooms? I have not started using AC yet, plan to open in a few months but am planning on using it. does this mean any one user cannot open multiple charts at once or throughout the whole system ie front desk, MA putting in a patient while am seeing another one etc, I can't imagine that is the case but wanted to clarify, seems like a pretty important piece of info that I haven't come across yet during my research. thanks. Mike

Another possible solution.

We have 5 windows logons in each room (myself, for 2 residents, front desk and MA). If one of the other persons, say one of the residents is not there I can go into their windows logon, CTRL-L will change the AC back to the logon screen and logon as myself. Then WINDOWS-L will return me to the logon screen where I can switch back to my logon and work on a different patient.

I then have to switch back and forth with WINDOWS-L between the logons to work with multiple patients. I need to check at the end of the day that I neither left an unfinished note (because I don't frequently log on as a resident) nor left it signed in under me and the resident then comes in another day and charts under my name (I would not have opportunity to review).

Clunky but it works

A Virtual Machine is just that, a virtual computer running on your computer. Check out VMWare Player and download a virtual machine like Ubuntu to play with. Microsoft also has VirtualPC for the same type of purpose. As for having charts open, more than one person can have a chart open. One person can only have one chart at a time open though. So say you open John Smith's chart, then you want to go into Jane Doe's chart, you need to close the first in order to open the second. Our office has not had issues with this and we have 5 providers and about 25 office employees. When they need to edit a different chart without losing the information they have put into the first chart, they simply forward the first one to their own inbox. It is really an easy thing to do and does not come up for us very often.

Wendell, I believe that would be nice for those that have Fast User Switching enabled. I still think that being able to have more than one window open would be a nice addition to AC.

Benjamin,
Sure I will add my vote if you put it in the wish list.

Oh, absolutely it would be better to have more than one window open at a time. I doubt it will be in V5, but we can wish.

I have mentioned to Jon about this in the past but don't know how high it is on his priority list. He gets a lot of requests and still manages to move forward.

EasyRider,

All great suggestions. And, for simply having the ability to open another chart while in a room, say to check what the brother's medication list shows, then many of the workarounds above will do.

You mentioned the tabs on a browser. You must remeber two things. First, it is much different downloading a web page to a browser than pulling two charts from Access. Now with SQL, this may change.

With what you're describing, VM seems to be the best bet. Virtual machines would not only solve the problem for the most part, but you would then have the ability to do testing on things as that is what VMs are for. To play with.

The downside would be cost. You would have to decide if it were worth it to you. If you have eight exam rooms, and you need two other OS in each, then you are looking at 16 more licenses. But, with three or so, it would be doable. As stated above some are free. VMWare even has a free one, although I use their Workstation version which costs money. But, it only has one license, so you would have to look at that. Again, you can put multiple OSs on one VM, so you could have 2 XP Pros and a Vista on one VM, but then you would have to pay for them. The other big issue would be RAM, VMs are just that, they are virtual but have their own hardware, etc.

Your computer OS and motherboard can probably only handle 4 GBs of RAM which equates to 3.2 MBs of RAM. So, if you have two other ACs open and you give them a GB, then you have only a GB of RAM on your "real" machine. Not too big of a problem for XP but a big problem for Vista.

You could download Microsoft Virtual PC and try it out. At first, they can be a bit tricky to set up, but all in all not a big deal.

I am sorry, Bert, I understood practically nothing from your post. I am just a user and I want to USE this program. I am not asking fancy things, am I? I am solo, have 3 rooms, I work fast, I put a lot of stuff to do for the nurse while moving to the next patient. Front might interrupt me asking certain things about pt who is on the phone and I need to look up the chart and make a decision on the spot. I have just noticed while writing this reply that I have open 8 tabs on Chrome, Skype, and Google Talk. I think that multitasking is the name of the game, and isn't it the quality we are seeking in our employees?

I apologize if my post was written in a confusing fashion. I agree it is great if you can just USE the program, but workarounds are one thing that can tide one over until the problem is fixed.

A virtual machine is just that. It is software that allows you to multitask as you say between OS. So, instead of Chrome, Skype and Goodgle Talk, you would have Windows XP, Win7 and 3 copies of Vista all running at the same time, or maybe just two other copies of XP. And, as an aside, which has nothing to do with your question or comments, Virtual Machines are the coolest things to ever come down the computing road. I certainly agree that it would be much better to open the charts from one program, but if I had the same need, I would simply have two other XP Pro OS minimized on my task bar especially since you can have 100 copies of AC for the same price as one.

Others have asked for the same thing, although not many. It would probably best best to talk directly with Jon about it. I am sure other EMRs have the ability, but they are probably more expensive.

I get messages about other patients from my staff all the time. If I need to open their charts, I don't find it that difficult to hit CTRL - S, open their chart and then click on the other patient's chart again.

I hope this doesn't come across like I am arguing; I am just trying to give you other options. All in all, it sounds as though this may not be the program for you unless Jon changes it so one can open more than one chart at a time.

EasyRider this is a neat solution, I use it all the time.

HotKeys.

I think you might fall in love w/ it. It allows you to open a chart, work on it partly, forward to your inbox VERY quickly with one key stroke. Then you can open another chart, do part of it, forward that back to your inbox. Work on another, etc.

While you cannot open multiple simultaneous charts in AC, this allows you to forward partially completed charts back to the inbox very quickly, thus circumventing the need to open multiple charts at once.

1) Go to Autohotkey.com and down load and install the application.
2) It is a script to simulate clicking the buttons to forward the chart to your inbox, by pressing the <Windows Key> + <C> at the same time. It instantly performs the forward chart action.
3)Open Notepad and enter the following verbatim.

#c::
send !c,
send {down}
send {enter}
return

4) Save the file as ForwardChart.ahk
5) Drag the file to Start Menu-->Program Files-->Startup

If you wish to have a script to sign off your chart note without clicking all the buttons, and doing the same thing near instantly do this.

1) After installing AutoHotkey application, Open Notepad and enter the following verbatim.

#s::
send !s!n!s{enter}!n!y
return

2)Save the file as SignNote.ahk
3)Drag the file to Start Menu-->Program Files-->Startup

Not to be Mr Negativity, but I actually like NOT being able to open two charts at once. Blame it on my failing memory or such, but I can easily see myself entering information on the wrong chart... an "oh crap, these scripts were supposed to go on his BROTHER'S chart" kind of thing, then I would be wasting time deleting the incorrect info and fixing my error. To me, that would take way more time than hitting control S to forward the chart to my inbox or hitting two mouse clicks to forward it to another staff member, and then opening the second chart. If I have an order for say an "EKG in room two", I forward room two's chart to my MA to do the ekg while I am in the next room opening the next chart. I really have no reason for room two's chart to still be open on my desktop while the ekg is being done. Plus, when room two's chart shows up back in my inbox from the MA, I know the ekg is finished and I can look at it. I feel the current system actually helps keep me more organized with less chance of incorrect data entry...and honestly I am less worried about incorrect entry on my part than I am on my staff's part. I can just see my MA's desktop now, with 47 open charts at once! If they were to add the ability to open multiple charts at once, I would like to see it as an option that could be enabled or disabled thru administrator functions.

Steve, that is a very good point. And, don't worry about the title, Mr. Negativity, I think that is already taken by me, lol.

I agree withh you Steve. Although there are times when it would be nice to have 2 charts open at once, it does open you up for all kinds of errors. But, I would like to be able to look at and scroll thru a patient's labs when I am trying to sign off on them(using the lab interface). Unfortunately, once I open the "sign off" box, the lab screen is locked, leading me to jot down notes when there are a lot of labs to review(or if I need to compare to an old lab).

And Bert, if you are "Mr Negativity" then I would hate to meet the guy who really deserves that title!

I will take that as a compliment David. If Leslie has anything to do with it, I am sure it would be someone working for Anthem.

LOL, Bert, I swear you somehow reply to my posts before I even hit the "submit" button! So David, you still can't look at the chart when you sign off on imported labs when they are imported using one of the lab interfaces? I had thought that was fixed but that must have been when I was running one of the beta's. Since we upgraded to the 4.0.73 version, I have not had our quest interface fixed so we were just importing the labs as pdf's for now. Back when we were using version 3.something, we started the quest interface and I hated it b/c of that fact - you had to close out of the lab sign off window to view the chart(and it was slower than molasses to reopen the imported labs with that database!). I remember being happy that they fixed that when I downloaded one of the V4 beta versions. Apparently they didn't keep that feature with the offical version...guess there is no rush to fix my quest interface at this point!

Steve,

I try to stay right on top of your posts, lol. I must be slacking, though. Last time it was 4 minutes, now it says 9 minutes, 29 seconds. But, I am actually heading home now.

PTOOT on Anthem

Leslie

Actually, Steve, I too have come to prefer not being able to open another patient's chart, although I was one who previously was in favor of it. I now have an excuse to separate husbands and wives, etc. into separate exam rooms rather than dealing with the unexpected "two-fers". When I am examining one and the other says, "Oh by the way, I am not tolerating that last medicine you put me on" I can say "let me have Ann put you in another room so I can pull you up on the computer. Unfortunately I cannot look at your chart here". (Blame it on the software). This then generates another separate superbill and another official visit.

Leslie

Steve, I didn't know that was fixed in the latest version as I am still on 3.7. If it is fixed, that might get me to finally do the update! (I have been delaying because I hope to do a big hardware upgrade soon too and planned on doing both at once)

Bert, that was supposed to be a compliment but as "Mr Negativity" you may not be able to see it that way! :-)

LOL. So, David, I know what your thought process is. I stayed at 3.7 for way longer than I wanted due to hardware upgrades. I think you are doing the right thing.

Dave,
I delayed just because I couldn't find the time to do the upgrade. I finally made time and am SOOOOOOO much happier w/ the new V4. It's much much better than V3.7. Don't wait, do the upgrade. That's my unsolicited advice.

I could have had a V4.

That's a V8 Bert.

Are you saying Version 8 is out?

Well maybe it was misinformation, but I heard that the AC programmers are skipping V5, V6, and V7 as well as all the in-betweens (v5.0.1.3's and v6.7.12's and v7.37.918's) and going straight for V8.

Is this in anyway connected to having to pay for recertification of CCHIT for those versions?

Didn't someone post on the ACUB that companies were going to have to pay for every new release version of their CCHIT certified EMR?

So make an upgrade, skip all the inbetween versions and pay less.